One of the most important factors in the rehabilitation of the amputee is the preparation of the patient and stump for limb fitting and training. The different procedures for the upper and lower extremities are described. Emphasis is laid on the importance of early reassurance and rehabilitation whenever possible. Patients unavoidably immobilised for long periods require general physical reconditioning before limb fitting and training can be undertaken. Special care is needed to avoid the upper limb amputee's becoming dependent on the surviving hand and using the artificial limb only for its cosmetic effect.

1. Congenital defects of the extremities are described. Although the detailed anatomy is infinitely variable, a broad classification in relation to prosthetic management has been suggested.

2. Most patients with these deformities can be fitted with a prosthesis without major surgical intervention. With this they will have at least as good function as they would have after amputation. A plea is made for a conservative attitude in this respect. It is suggested that recourse to amputation should be confined to cases in which prosthetic equipment falls short of functional and cosmetic requirements, and that, when possible, it should be deferred until the child is old enough to share in the decision.

3. The prostheses applicable to the various types of deformity are briefly described.

4. The application of similar techniques to cases of acquired shortening is mentioned.

5. The incorporation of certain features of artificial arms in flail arm splints is discussed.

1. The record is presented of an attempt to treat osteochondritis dissecans on idealistic lines.

2. The operative technique to be adopted in the various circumstances likely to be encountered in the knee joint is described. Two cases affecting the talus are recorded.

3. The radiological appearance has become virtually normal in twenty-seven cases (the remaining four are recent); healing has been observed directly in seven cases in which a second operation to remove the means of internal fixation was necessary; and the patients' complaints have been eliminated, but the long term results of treatment are unknown.

4. Suggestions are made for possible developments in the technique of operation.

1. Three patients suffering from osteochondritis dissecans in several joints, and all below average height, are described.

2. There was evidence of a constitutional upset in each case.

3. It is suggested that there was an underlying endocrine imbalance at puberty.

1. The pathological anatomy of osteochondritis dissecans of the hip is described, and its causation is discussed.

2. Eight new cases are reported.

3. The problems of treatment are considered.

1. Dislocation or sublaxation of the inferior radio-ulnar joint in association with fractures of the head of radius is discussed.

2. The incidence of the complication is greater than is generally supposed, and figures are given to support this finding.

3. The subluxation is not always associated with symptoms, and the degree of displacement may not be sufficient to be recognised clinically.

4. The anatomy and mechanism of the displacement have been investigated experimentally, and the results of the experiments are described.

1. Three cases of tenosynovitis presenting as the first manifestation of rheumatoid arthritis are described.

2. An account is given of the histology of the affected tendon sheaths.

1. A case of dysplasia epiphysialis punctata is described, with some histological observations.

2. Both parents were syphilitic.

3. The etiology is not yet fully determined. Some suggestions are put forward for further investigation.

1. A case is described of fatigue fractures occurring in the lowest thirds of the right tibia and fibula simultaneously.

2. The fibular fracture was a runner's fracture.

3. The tibial fracture was ascribed to the application of a below-knee walking plaster to treat the fibular lesion.

4. Both fractures were slow in uniting.

5. The fractures occurred in a rapidly growing youth but no clinical evidence of an endocrine dysfunction was found.

Complete reduction of a dislocated hip may be blocked by a partial separation of the acetabular rim. The diagnosis is radiological and is easily missed. Treatment is by open operation and resection of the partly detached fibrocartilaginous rim.

A case of posterior fracture-dislocation of the hip complicated by displacement of a segment of the acetabular rim into the joint at the time of closed reduction is reported.

In treatment, it is stressed that the posterior approach to the hip should be used to minimise further damage to the soft tissues about the joint.

1. A report is given of a family suffering from dystrophia myotonica and familial Paget’s disease of bone.

2. Radiological changes in the skull occur in both disorders, which are quite dissimilar. Thickening of the calvarium, however, may be common to both.

3. The serum alkaline phosphatase is high in Paget's disease and normal in dystrophia myotonica.

4. In one patient the Paget's disease was complicated by the development of multiple sarcomata. Sarcomatous involvement of the vertebral column, observed in one of the cases, has not been recorded before.

1. Previous studies of the movements of the lumbar spine are criticised in the light of new observations from radiograph tracings. It is shown that, contrary to recent teaching, the lumbar spine is a very mobile part of the vertebral column.

2. The movement of the lumbar spine is analysed. It is shown that the lower vertebrae have the most movement, and that the range gradually becomes less in the upper lumbar spine.

3. This movement may be roughly correlated with the incidence of spurs arising from the anterior margin of the vertebral bodies.

4. These spurs are shown to arise in the anterior longitudinal ligament; they are probably caused by intermittent pressure from the intervertebral disc lying behind the ligament.

1. In five out of eleven cases of osteoclastoma it was found that osteoclasts were present inside clearly defined blood vessels either within the tumours or in the tissues immediately surrounding the tumours. In two further cases it was found that osteoclasts protruded into the vessels although they were not lying free within the vessels.

2. The possible modes of entry of these cells into the blood stream are discussed. Although accidental dissemination of osteoclasts into damaged blood vessels could not be excluded, it was felt that the process was equally likely to be related to some inherent property of the osteoclasts. From further observations it is suggested that osteoclasts are capable of local destruction of the connective tissues of the vessel walls, probably by enzyme action. Such an action might be analogous to the processes by which, in the opinion of many, osteoclasts bring about the resorption of bone.

3. There did not seem to be any relationship between the finding of intravascular osteoclasts and the malignancy of the tumour, assessing the latter either on histological or clinical grounds. The finding of intravascular osteoclasts does not therefore appear to be of any prognostic significance.

1. The results of a study of the characteristics of the vessels found in forty-six human femoral heads during the growth period are described.

2. Of the three different sources of blood entering the human adult femoral head it was found that from birth to about three to four years the vessels of the ligamentum teres do not contribute to the nourishment of the head.

3. After the fourth year the metaphysial vessels decrease in importance until they finally disappear, leaving the head with only one source of blood through the lateral epiphysial vessels; the ligamentum teres is not yet contributing to the circulation of the head.

4. After about eight or nine years it was found that the vessels of the ligamentum teres contribute to the blood supply of the head while the metaphysial blood flow is still arrested.

5. Finally, at puberty, after a period of activity of the metaphysial vessels, epiphysial fusion takes place, bringing together the three sources of blood characteristic of the adult.

1. The rates of vascularisation in 119 autogenous, homogenous and heterogenous bone grafts, placed in the femoral medullary cavity and under the renal capsule of rabbits, were studied.

2. Substantial differences have been found in the speed of vascular penetration and arrangement among autografts, homografts and heterografts : penetration of the heterogenous implant was six or more times slower. Moreover, large areas of the homografts and heterografts were often totally excluded from the circulation for as long as the research was continued (up to three months). Revascularisation of the cortical bone was slower and less profuse than in cancellous bone, keeping always the same respective proportion between the three types of bone we have described. The results on the kidney were much less constant, and I attribute this to the vascular peculiarities of the bed.

3. Vascular patterns peculiar to the time of implantation and type of graft are described.

4. Suggestive, even if not totally convincing, evidence was found of recanalisation of old vessels inside the graft by advancing vessels from the bed.

5. There is striking correlation between the rate of vascular penetration of the bone implants and their ultimate "take" or incorporation in the bed.